Healthcare Provider Details

I. General information

NPI: 1295918324
Provider Name (Legal Business Name): SOUTHWEST FAMILY MEDICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COURT ST.
CLAYTON NM
88415
US

IV. Provider business mailing address

PO BOX 157
CLAYTON NM
88415-0157
US

V. Phone/Fax

Practice location:
  • Phone: 575-374-2020
  • Fax: 575-374-2040
Mailing address:
  • Phone: 575-374-2020
  • Fax: 575-374-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2958205
License Number StateNM

VIII. Authorized Official

Name: MRS. JESSIE JEAN FLUHMAN
Title or Position: OWNER
Credential: FNP
Phone: 575-374-2020